Preventing Pneumonia??

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Prior Pneumococcal Vaccination Improves Survival in Elderly With Pneumonia

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By Martha Kerr

NEW YORK (Reuters Health) Apr 27 - In elderly patients hospitalized with community-acquired pneumonia, a history of pneumococcal vaccination is linked to a decreased chance of respiratory complications, a decreased length of stay and improved survival, overall, according to a report in the April 15th issue of Clinical Infectious Diseases.

Dr. David N. Fisman of Princeton University, New Jersey, and colleagues studied 62,918 adults with community-acquired pneumonia admitted to hospitals operated by the nationwide Tenet Healthcare Corp. The investigators looked at vaccination status, comorbidities and outcomes.

Of the total, 12% had a record of prior pneumococcal vaccination. However, that apparently low rate of vaccination "needs to be taken with a bit of a grain of salt here," Dr. Fisman told Reuters Health.

"We found a record of vaccination in 12% of the individuals in the study, but over half of the study subjects had no record of either being vaccinated or unvaccinated, and were probably a mix of the two," he explained. "Among individuals whose vaccine status was known, around one-third had received vaccine and two-thirds had not."

Compared with individuals with no record of prior vaccination, vaccine recipients were less likely to die of any cause during hospitalization (odds ratio, 0.50) even after adjusting for comorbidities, age, smoking status and influenza vaccine status.

Vaccine recipients were also less likely to develop respiratory failure (odds ratio, 0.67) and had a median length of stay in the hospital that was 2 days shorter than those who were unvaccinated.

"There is some evidence to suggest that pneumococcal vaccination actually prevents pneumonia," Dr. Fisman said. "Vaccinated individuals may be under-represented in this study because they were actually kept out of the hospital by being vaccinated previously," he pointed out.

"We found that individuals admitted to hospital during winter months enjoyed greater protection from prior vaccination," Dr. Fisman added. "It is definitely worth offering this vaccine whenever eligible folks are 'captured,' whether that is in the primary care clinic setting, or when hospitalized for pneumonia."

The Tenet Healthcare data collection "occurred as part of an effort to ensure that anyone admitted for pneumonia who had not been vaccinated previously, received (pneumococcal vaccination), and the flu vaccine, too," Dr. Fisman commented.

Clin Infect Dis 2006;42:1093-1101.

RIGHTS IN A PANDEMIC DEBATED IN FORUM

By Barbara Feder Ostrov

Mercury News

Here's how a worldwide flu epidemic might start:

A sales manager for a multinational corporation returns to his California office from a business trip to Vietnam, feeling sick.

Within days this otherwise healthy man is near death. Other employees come down with a flu-like illness. A cleaning woman dies.

Tests show he has infected his co-workers with a form of bird flu that originated in Asia. Public health officials fear the worst: an outbreak of deadly pandemic flu.

What responsibility does the multinational corporation have to its workers? Can public health officials make residents stay in their homes to prevent the spread of disease? Can the government commandeer a local doctor's supply of Tamiflu for people who need it most, or force nurses to be vaccinated? What if frightened nurses refuse to work?

That scenario, and the troubling legal and ethical questions it raises, were the topic of a Wednesday conference of attorneys and public health workers in Millbrae, sponsored by the Berkeley-based Public Health Institute.

In any disease outbreak, there is a tension between civil liberties and the need to protect the public's health, said Marice Ashe, who directs the institute's Public Health Law Program.

``Forced vaccinations, searches for supplies of vaccine, the financial losses of a convention center that's forced to close -- all of these actions have major legal implications,'' Ashe said. ``We need to be able to move quickly in a pandemic. The goal is to save lives.''

As federal, state and local governments develop plans to deal with a possible outbreak, lawyers are wrestling with how to protect individual liberties and property rights without getting in the way of public health workers. It could be a difficult task.

Who's liable if someone has a fatal reaction to flu vaccine in the midst of a pandemic?

Federal law requires hospital emergency rooms to stabilize patients before transferring them, but would that be realistic when thousands of people need treatment? Could a hospital be sued for a flu patient's death if it didn't have enough ventilators available?

The nation's legal system doesn't necessarily have answers to these questions, nor could it address them quickly. Yet local officials will have to act with haste, in the absence of good information, to try to contain local outbreaks once they occur, said conference organizers.

In a declared state of emergency, public health officers have the authority to commandeer hospitals and supplies, shut down large gatherings, quarantine infected people and control how vaccines and medications are distributed.

On the other hand, while California law allows health authorities to command the aid of citizens or health workers in an epidemic, it's nearly impossible to force people to work against their will.

As a practical matter, some regulations -- such as those protecting patient privacy -- might have to be temporarily set aside, experts said.

The H5N1 bird flu virus, which is not easily transmitted from person to person, has killed more than half of the 204 people who have been confirmed infected, according to the World Health Organization. Health experts believe that this particularly virulent form of avian flu, circulating in Asia and the Middle East, could mutate into a highly contagious virus that could spark the world's next pandemic of influenza.

The worldwide outbreak of Spanish flu in 1918 killed 40 million people, and flu outbreaks in 1957 and 1968 each killed more than 1 million people.

``We must try to address these issues now, while we still have some little luxury of time -- although we don't know how much time,'' said Carol Klove, chief compliance and privacy officer for the University of California-Los Angeles.

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IF YOU'RE INTERESTED

For more information on planning for pandemic flu, visit www.pandemicflu.gov.

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Contact Barbara Feder Ostrov at bfeder@mercurynews.com or (408) 920-5064.

England culls for bird flu

Britain to cull 35,000 chickens after bird flu found on farm Apr 26 6:53 PM US/Eastern Email this story

Some 35,000 chickens will be slaughtered on a farm in eastern England following the discovery of bird flu among a number of dead poultry there, an environment ministry spokesman said.

Initial tests on the fowl found the H7 strain of avian influenza rather than H5N1, which is potentially lethal to humans, the Department for the Environment, Food and Rural Affairs said.

The spokesman said further tests were being carried out to determine the N-strain of the virus.

The H7 strain of bird flu itself has the potential to be highly pathogenic and a grave threat to poultry.

Britain suffered sporadic outbreaks of H7 in 1985 and 1977.

The environment ministry said in a statement: "Preliminary tests have this evening indicated that the avian influenza virus is present in samples from chickens found dead on a poultry farm near Dereham in Norfolk."

All other fowl on the farm will be slaughtered as a precautionary measure, it said.

The spokesman told AFP: "There are some 35,000 poultry on the farm."

Restrictions have been placed on the location and may be reassessed following further results from the laboratory.

Britain's first case of the H5N1 strain of bird flu was discovered in a wild dead swan in Scotland earlier this month.

But no other birds have since tested positive for H5N1, which has caused the deaths of more than 100 people, mainly in Asia.

Make a list and start buying/collecting

Many lists can be found on the internet to help your family plan for the pandemic flu. The supplies are often the same ones you should have on hand for earthquake, flood or hurricaine. The main difference is the length of time your supplies should last. Most are recommending a 6 week supply; but I have seen up to a year recommended. The following is from the CDC website and is a good starting point for planning.

You can prepare for an influenza pandemic now. You should know both the magnitude of what can happen during a pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you and your family. This checklist will help you gather the information and resources you may need in case of a flu pandemic.

1. To plan for a pandemic:
• Store a supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.
• Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
• Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.
• Volunteer with local groups to prepare and assist with emergency response.
• Get involved in your community as it works to prepare for an influenza pandemic.


2. To limit the spread of germs and prevent infection:
• Teach your children to wash hands frequently with soap and water, and model the correct behavior.
• Teach your children to cover coughs and sneezes with tissues, and be sure to model that behavior.
• Teach your children to stay away from others as much as possible if they are sick. Stay home from work and school if sick.


3. Items to have on hand for an extended stay at home:

Examples of food and non-perishables	Examples of medical, health, and emergency supplies
Ready-to-eat canned meats, fruits, vegetables, and soups	Prescribed medical supplies such as glucose and blood-pressure monitoring equipment
Protein or fruit bars	Soap and water, or alcohol-based hand wash
Dry cereal or granola	Medicines for fever, such as acetaminophen or ibuprofen
Peanut butter or nuts	Thermometer
Dried fruit	Anti-diarrheal medication
Crackers	Vitamins
Canned juices	Fluids with electrolytes
Bottled water	Cleansing agent/soap
Canned or jarred baby food and formula	Flashlight
Pet food	Batteries
	Portable radio
	Manual can opener
	Garbage bags
	Tissues, toilet paper, disposable diapers

Family Emergency Health Information Sheet

Emergency Contacts Form

For More Information

• Visit: www.pandemicflu.gov
• The Centers for Disease Control and Prevention (CDC) hotline, 1-800-CDC-INFO (1-800-232-4636), is available in English and Spanish, 24 hours a day, 7 days a week. TTY: 1-888-232-6348. Questions can be e-mailed to cdcinfo@cdc.gov.
• Links to state departments of public health can be found at http://www.cdc.gov/other.htm#states.

U.S. Department of Health and Human Services
January 2006

Update from the CDC on avian influenza

Been a bit dry on my blog lately what with all the facts that need to be shared. I hope someone is paying attention. Cannot tell if anyone is reading this or not, but I will continue to post current news and my opinions about it.

Assessment of Current Situation

The avian influenza A (H5N1) epizootic (animal outbreak) in Asia and parts of Europe is not expected to diminish significantly in the short term. It is likely that H5N1 infection among birds has become endemic in certain areas and that human infections resulting from direct contact with infected poultry will continue to occur. So far, the spread of H5N1 virus from person-to-person has been rare and has not continued beyond one person. No evidence for genetic reassortment between human and avian influenza A virus genes has been found; however, the epizootic in Asia continues to pose an important public health threat.

There is little pre-existing natural immunity to H5N1 infection in the human population. If these H5N1 viruses gain the ability for efficient and sustained transmission among humans, an influenza pandemic could result, with potentially high rates of illness and death. In addition, genetic sequencing of influenza A (H5N1) viruses from human cases in Vietnam and Thailand shows resistance to the antiviral medications amantadine and rimantadine, two of the medications commonly used for treatment of influenza. This would leave two remaining antiviral medications (oseltamivir and zanamivir) that should still be effective against currently circulating strains of H5N1 virus. Efforts to produce vaccine candidates that would be effective against avian influenza A (H5N1) viruses are under way. However, it will likely require many months before such vaccines could be mass produced and made widely available.

Research suggests that currently circulating strains of H5N1 viruses are becoming more capable of causing disease (pathogenic) in animals than were earlier H5N1 viruses. One study found that ducks infected with H5N1 virus are now shedding more virus for longer periods without showing symptoms of illness. This finding has implications for the role of ducks in transmitting disease to other birds and possibly to humans as well. Additionally, other findings have documented H5N1 infection among pigs in China and H5N1 infection in felines (experimental infection in housecats in the Netherlands and isolation of H5N1 viruses in tigers and leopards in Thailand).In addition, in early March 2006, Germany reported H5N1 infection in a stone marten (a weasel-like mammal). The avian influenza A (H5N1) virus that emerged in Asia in 2003 continues to evolve and may adapt so that other mammals may be susceptible to infection as well.

Notable findings of epidemiologic investigations of human H5N1 cases in Vietnam during 2005 have suggested transmission of H5N1 viruses to at least two persons through consumption of uncooked duck blood. One possible instance of limited person-to-person transmission of H5N1 virus in Thailand has been reported. This possibility is being further investigated in other clusters of cases in Vietnam and Indonesia.

The majority of known human H5N1 cases have begun with respiratory symptoms. However, one atypical fatal case of encephalitis in a child in southern Vietnam in 2004 was identified retrospectively as H5N1 influenza through testing of cerebrospinal fluid, fecal matter, and throat and serum samples. Further research is needed to ascertain the implications of such findings.

Bird Import Ban

There is currently a ban on the importation of birds and bird products from H5N1-affected countries. The regulation states that no person may import or attempt to import any birds (Class Aves), whether dead or alive, or any products derived from birds (including hatching eggs), from the specified countries. For more information, see Embargo of Birds from Specified Countries.

Travel

Updated Information for Travelers about Avian Influenza A(H5N1) is available at the CDC Travelers’ Health Web site. Also see Guidelines and Recommendations - Interim Guidance about Avian Influenza A (H5N1) for U.S. Citizens Living Abroad.

CDC Response

Domestic Activities

• In May 2005, CDC joined a new, inter-agency National Influenza Pandemic Preparedness Task Force organized by the U.S. Secretary of Health and Human Services. This task force is developing and refining preparedness efforts with international, state, local, and private organizational partners to help ensure the most effective response possible when the next influenza pandemic occurs. For more information about the Pandemic Influenza Preparedness Plan of the U.S. Health and Human Services Department and other aspects of this coordinated federal initiative, please visit www.pandemicflu.gov.
• CDC developed the first test approved by FDA for the detection of the H5 viruses that first emerged in Asia in 2003.
• CDC reconstructed the 1918 Spanish influenza pandemic virus to help develop strategies for early diagnosis, treatment, and prevention, if a similar pandemic virus emerged.
• CDC has collaborated with the Association of Public Health Laboratories to conduct training workshops for state laboratories on the use of molecular techniques to rapidly identify H5 viruses.
• CDC is working collaboratively with the Council of State and Territorial Epidemiologists and other partners to assist states with pandemic planning efforts.
• CDC is working with other agencies, such as the Department of Defense and the Department of Veterans Affairs, on antiviral stockpile issues.

International Activities

• CDC is one of four WHO Collaborating Centers and in this capacity provides ongoing support for the global WHO surveillance network, laboratory testing, training, and other actions.
• CDC has worked collaboratively with WHO to conduct investigations of human H5N1 infections in China, Indonesia, Thailand, Vietnam, and Turkey and to provide laboratory diagnostic and training assistance.
• CDC has performed laboratory testing of H5N1 viruses from Vietnam, Thailand, and Indonesia.
• CDC is implementing a multi-million dollar initiative to improve influenza surveillance in Asia.
• CDC has led or taken part in 9 training sessions to enhance local capacities in Asia to conduct surveillance for possible human cases of H5 and to detect avian influenza A H5 viruses using laboratory techniques.
• CDC has developed and distributed a reagent kit for the detection of the currently circulating influenza A H5 viruses.
• CDC has worked with other international and national agencies in Asia to develop a training course for rapid response teams that will be used to help prepare the region to respond to outbreaks when they occur.
• CDC has developed an international program to support surveillance, laboratory capacity, health education, rapid response training, and other activities for avian influenza.

CDC is monitoring the situation closely, along with WHO and other international partners. In addition, CDC continues to work collaboratively with WHO and the National Institutes of Health (NIH) on the development and testing of vaccine seed candidates for influenza A (H5N1).

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NOTE: The World Health Organization (WHO) maintains situation updates and cumulative reports of human cases of avian influenza A (H5N1).

Page last modified April 24, 2006

pandemic level 4 ??

H5N1 Pandemic Level 4 Declared by Research Team Citing 23 Clusters and Case Histories

Using the World Health Organizations own guidelines for determining pandemic level status, an independent research team has gathered enough factual H5N1 data to substantiate the need to declare a "Pandemic Level 4" response to Avian Flu. The Information that supports this claim is derived from scientific and medical papers, laboratory reports, government, geneticist, virologist and other experts around the world.
(PRWEB) April 23, 2006 -- Using the World Health Organizations own guidelines for determining pandemic level status, an independent research team has gathered enough factual H5N1 data to substantiate the need to declare a "Pandemic Level 4" response to Avian Flu. The Information that supports this claim is derived from scientific and medical papers, laboratory reports, government, geneticist, virologist and other experts around the world. The combined effort focused on a three year period from 2003 to the 2006, listing 23 documented clusters of H2H. The report is based on millions of Internet searches and thousands of hours verifying data."Clusters of H5N1 infections," says one research member "They may indicate human to human transmission of H5N1 influenza or alternatively indicate common exposure to the virus from an environmental source, presumably avian. A cluster here is defined as two or more individuals: 1. Who are in close physical contact, 2. Who become very sick with a respiratory disease, and 3. at least one of whom is a confirmed H5N1 influenza case. China - 2003 FebruaryA family of 5 from Hong Kong visited Fujian province in Mainland China early in 2003. A mother went with two daughters and one son on January 25, 2003. The 7 year old girl developed respiratory symptoms and a high fever on January 27/28. She developed pneumonia on January 28 2003. The father joined his family in Fujian province on January 31. His 7 year old daughter died on February 4, 2003. She was not tested for H5N1 and was buried in Mainland China. Her 33 year old father became ill on February 7 with fever, cough and blood in sputum. The family returned to Hong Kong on February 9 2003. The father was admitted to a hospital in Hong Kong on February 11. He died on February 17. He was tested and was found to have been infected with H5N1. The 8 year old boy in the family became ill with a cough and fever on February 9, 2003. He was tested and was also found to be positive for H5N1, but recovered. Peiris et al 2004 Viet Nam - 2003 DecemberA 12 year old girl from Ha Nam became ill on December 25 2003 and was admitted to a Hanoi hospital on December 27 2004. She died on December 30 2003. This is first confirmed death from H5N1 in Viet Nam. Her 30 year old mother became ill on January 1 2004 and died of H5N1 influenza on Jan 9 2004. Corresponds to Olsen et al. cluster 1 A 7 year old girl Nam Dinh died on December 29 2003 of acute respiratory distress. No samples were tested from this girl. Her 5 year old brother was admitted to the hospital on December 29 2003. He died 17 days after becoming ill. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 2 Viet Nam - 2004 JanuaryA family cluster of H5N1 infections was observed in Thai Binh province in January 2004 (see also WHO update 15). A 31 year old man was hospitalized on January 7 2004 with severe respiratory illness. He died on January 12. No samples from this patient were tested for H5N1. His 28 year old wife became ill with a severe respiratory illness on January 10, but recovered. H5N1 infection was confirmed. The man’s two sisters, 23 and 30 years old, became ill on January 11 and January 10, respectively. Both died on January 23. H5N1 infection was confirmed in both sisters. Corresponds to Olsen et al. cluster 3 Viet Nam - 2004 January-FebruaryA 9 year old girl in Dong Thap province became ill with diarrhea, but no respiratory symptoms on January 28 2004. She died of acute encephalitis on February 2 2004. She was not tested for H5N1 influenza. Her 4 year old brother became ill with diarrhea on February 10 2004, also with no respiratory symptoms. He developed encephalitis and died of respiratory failure on February 17 2004. This 4 year old boy was tested for H5N1 influenza and found to be positive. Viet Nam - 2004 JulyA 19 year old man in Hai Giang province became ill on July 23, 2004 with symptoms of fever, breathing difficulties and hemorrhage. His 22 year old female cousin exhibited the same symptoms. They both died on July 30. They were not tested for H5N1 infection. The man’s 25 year old sister became ill with the same symptoms on July 31 2004. She died on August 2 2004. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 5 Thailand - 2004 SeptemberA family cluster of H5N1 and severe respiratory illness was observed in September 2004 in Kamphaeng Phet province. A 11 year old girl from Kamphaeng Phet province became ill on September 2 2004 and died of pneumonia on September 8 2004. She was not tested for H5N1 infection, but was considered to be a probable H5N1 fatality. Her 26 year old mother lived in Bangkok but visited her daughter to take of her while she was ill. The mother became ill on September 11 2004 and died on September 20. H5N1 infection was confirmed. The girl lived with her 32 year old Aunt. The Aunt became ill on September 16 2004 but recovered. H5N1 infection was confirmed. The Aunt’s son became ill with a respiratory infection. This cluster is considered one of the most convincing cases of human-to-human transmission of H5N1 because the mother lived in an area which had no infected birds, Bangkok, and was exposed to H5N1 by her daughter (who did have exposure to sick chickens). Corresponds to Olsen et al. cluster 6 Viet Nam - 2005 JanuaryA 45 year old man from Thai Binh became ill with a respiratory illness on December 26 2004 and died on January 9 2005. H5N1 influenza was confirmed. His 42 year old brother, from Hanoi, was hospitalized on January 10 but recovered. He was also confirmed to be infected with H5 influenza. A third 36 year old brother was reported to be positive for H5N1 infection, but did not exhibit any symptoms Corresponds to Olsen et al. cluster 7 A 17 year old boy from Bac Lieu was hospitalized on January 10 2005. He died of H5N1 influenza on January 14 2005. His 22 year old sister also had respiratory symptoms and was hospitalized. Her fate and H5N1 status were not reported.Corresponds to Olsen et al. cluster 8 A 35 year old woman from Dong Thap became ill on January 14 2005. She died of H5N1 influenza on January 21. Her 13 year old daughter became ill on January 20 2005. She later died. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 9 Cambodia - 2005 JanuaryA 14 year old boy from Kampot province became ill with respiratory symptoms and died on January 20 2005. He was not tested for H5N1 infection. His 25 year old sister became ill on January 21 2005. She traveled to Vietnam to receive care but died on January 30. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 10 Viet Nam - 2005 FebruaryA 21 year old man from Thai Binh province ate meat from a sick chicken on February 8 2005. He developed a high fever and cough on February 14 2005. On February 20, he was admitted to an hospital with severe pneumonia. He received oseltamivir (Tamiflu -75 mg twice a day for 7 days) on February 23. He was discharged from the hospital on May 13. H5N1 infection was confirmed. His 14 year old sister cared for him from February 14 to February 21. She became ill with a mild cough and mild fever on February 23 2005. H5N1 infection was confirmed. She received an initial treatment with oseltamivir (Tamiflu -75 mg once a day) from February 24 to February 27. She was admitted to a hospital for observation on February 24. At this time, she had no fever but did have a mild cough. On February 27, she developed a high fever and severe cough. On February 28, she received oseltamivir (Tamiflu -75 mg twice a day for 7 days). She was discharged from the hospital on March 14 2006. The girl had no contact with poultry prior to becoming ill. A 26 year old male nurse, who cared for 21 year old male patient mentioned above, was admitted to a hospital in early March. H5N1 infection was apparently detected. The 80 year old grandfather of the 21 year old and 14 year old brother and sister was reported to be infected with H5N1. He did not exhibit any symptoms. Corresponds to Olsen et al. cluster 11 Viet Nam - 2005 MarchFive members of a family in the city of Haiphong were all reported to be infected with H5N1 influenza and were hospitalized on March 22 2005. The 35 year old father, 33 year old mother, 13 year old daughter, 10 year old daughter and 4 month old daughter were all infected. Corresponds to Olsen et al. cluster 14 Indonesia - 2005 JulyAn 8 year old girl from Tangerang, a suburb of Jakarta, became ill on June 24 2005 and died on July 13. She was reported to be H5N1 positive, but was later judged by the WHO not to have an acute H5N1 infection. Her 1 year old sister became ill on June 29 2005 and died on July 9. She was not tested for H5N1 infection. The father of the two girls, a 38 year old man, became ill on July 2 2005 and died on July 12 2005. H5N1 infection was confirmed. Corresponds to Olsen et al. cluster 15 Indonesia - 2005 SeptemberOn September 10 2005 a 37 year old woman from Jakarta died of confirmed H5N1. Her 9 year old nephew became sick with respiratory symptoms. Initially he tested postive with PCR. It was later reported that he was not infected with H5N1. On September 20 2005 a 21-year-old man from Lampung province developed symptoms. On September 24 2005 he was hospitalized; H5N1 infection was confirmed. On October 4, the 4 year old nephew of this man became ill. H5N1 infection was confirmed. China - 2005 OctoberOn October 8 2005, a 12 year old girl from Hunan province became ill with respiratory symptoms. She died on October 16. Her 9 year old brother became ill with respiratory symptoms on October 10 2005. He was confirmed to be infected with H5N1. He was released from the hospital on November 12 2005. Thailand - 2005 OctoberA 48-year old man from Kanchanaburi province became ill on October 13 2005 and died on October 19. His 7 year old son became ill on October 16, but recovered. H5N1 infection was confirmed in both cases. Indonesia - 2005 OctoberOn October 19 2005, a 19 year old woman from Tangerang became ill. She died on October 28. Her 8 year old brother became ill on October 25. H5N1 infection was confirmed in both cases. Indonesia - 2005 NovemberOn November 3, two brothers, ages 7 and 20, from West Java province developed fever and respiratory symptoms. They died on November 11. On November 6, their 16 year old brother also developed fever and respiratory symptoms. He was hospitalized on November 16. H5N1 infection was confirmed in the 16 year old. The 7 year old and 20 year old were not tested for H5N1. Turkey - 2006 JanuaryThe first reported case of H5N1 influenza in Turkey occurred in a 14 year old boy from Dogubayazit, in the province of Agri. He died on January 1 2006. His 15 year old sister died of H5N1 influenza on January 5 2006. The 12 year old sister of these children died on January 6 2006. The 6 year old brother of these children was hospitalized. Two brothers, 5 and 2 years old, from Ankara province were reported infected with H5N1 on January 8 2006. A 9 year old girl and her 3 year old brother, from the Dogubeyazit district in Agri Province, were reported infected on January 9 2006. A 14 year old girl from the Dogubayazit district of Agri province became ill on January 4 2006. She died of H5N1 influenza on January 15. Her 5 year old brother also became ill on January 4 2006. He was confirmed to be infected with H5N1 influenza. Indonesia - 2006 JanuaryOn January 6 2006, a 13 year old girl became ill. She died of H5N1 influenza on January 14. On January 8 2006, her 4 year old brother became ill. He died of H5N1 influenza on January 17. Their 14 year old sister was hospitalized with respiratory symptoms on January 14 2006. Their 43 year old father was hospitalized on January 17 with respiratory symptoms. On January 19 2006, a 9 year old girl from a neighboring village was hospitalized, but later recovered. H5N1 infection was confirmed. Iraq - 2006 JanuaryThe first person reported to contract H5N1 influenza in Iraq was a 15 year old girl from the town of Raniya. She became ill on January 2 2006 and died on January 17. A US naval Medical Research Unit located in Cairo, Egypt confirmed infection with H5N1. Her 39 year old uncle, who cared for her while she was sick, became ill on January 24 2006. He died of a respiratory illness on January 27. H5N1 infection was confirmed in the uncle. Indonesia - 2006 FebruaryA 12 year old girl from Boyolali, Central Java became ill on February 19 2006. She died on March 1. H5N1 infection was confirmed. Her 10 year old brother also became ill on February 19 and died February 28. He was not tested for H5N1. Azerbaijan - 2006 MarchA 17 year old girl from Salyan Rayon died on February 23 2006. H5N1 infection was confirmed. Her first cousin, a 20 year old woman from Salyan Rayon died on March 3. H5N1 infection was confirmed. This woman’s 16 year old brother died on March 10. H5N1 infection was confirmed. A 17 year old girl, who was a close friend of this family, died on March 8. H5N1 infection was confirmed. A 10 year old boy from Salyan Rayon became ill. H5N1 infection was confirmed. A 15 year old girl from Salyan Rayon became ill. H5N1 infection was confirmed. Egypt - 2006 March-AprilA 6 year old girl from the Kafr El-Sheikh governorate became ill. H5N1 infection was confirmed. Her 1.5 year old sister became also became ill. H5N1 infection was confirmed."We substantiate the claim based on the data above to elevate the current WHO pandemic level from 3 to 4," says Cornelius Robertson team spokesman. "The importance of recognizing level 4 is a key to minimizing public heath impact and the welfare of the general public. By informing the public of pandemic flu alert from level three to four would increase survivability from this natural flu cycle. Pandemics run in historical waves every 30-45 yearsRobertson continues, "Evidence points to global organizations and world governments reacting in the same manner as in the 1918 Spanish Flu pandemic which killed Tens of millions. Either for social economic reasons, geographical differences there is much foot dragging and under reporting in areas of like Africa the Middle East and Southeast Asia."In this information age, using online resources of thousands of data bases, the team compiled its opinion. "We say facts are facts. We are declaring Pandemic level 4 for Avian Influenza."Sourceshttp://www.who.int/csr/disease/avian_influenza/updates/en/index.html http://www.cdc.gov/ncidod/EID/vol11no11/05-0646.htm http://www.promedmail.org/pls/askus/f?p=2400:10001:1001333047747557695 http://www.recombinomics.com www.avianflutalk.com# # #